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Acute severe ulcerative colitis with toxic megacolon risk — SCE Acute Medicine MCQ

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ModerateGastroenterology and hepatologyAcute severe ulcerative colitis with toxic megacolon riskSCE Acute Medicine

A 29-year-old man with ulcerative colitis presents with 8 bloody stools per day, fever and abdominal distension. Pulse is 118/min, CRP is 156 mg/L and abdominal radiograph shows transverse colon diameter of 6.4 cm. He has been taking oral prednisolone for 5 days. What is the most appropriate next step in management?

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Correct answer: A — Start intravenous hydrocortisone with early surgical assessment

Frequent bloody stools with systemic toxicity and colonic dilatation require inpatient acute-severe-colitis care. Intravenous corticosteroid, thromboprophylaxis, stool infection testing, daily objective reassessment and early colorectal-surgical involvement are needed. Antimotility drugs and full colonoscopy can precipitate deterioration.

Reference: https://www.nice.org.uk/guidance/ng130/chapter/recommendations